1. US Trends in Refractive Surgery: 2011 ASCRS Survey Richard J. Duffey, MD David Leaming, MD Chicago: April 21, 2012

2. Disclosures The authors have no financial interest in this study or the matters discussed. The authors have no financial interest in this study or the matters discussed. Duffey 2012

3. 2011 ASCRS Survey September 2011 emailing to 4236 U.S. members of ASCRS. September 2011 emailing to 4236 U.S. members of ASCRS. Third time totally ONLINE Survey. Third time totally ONLINE Survey. 1525 opened emails with 463 responding representing 11% response rate (30% response rate of those opened) in the U.S. [approximately same response with previous general and email surveys]. 1525 opened emails with 463 responding representing 11% response rate (30% response rate of those opened) in the U.S. [approximately same response with previous general and email surveys]. Sixteenth year of refractive data collection allowing analysis and comparison of trends amongst ASCRS U.S. surgeons. Sixteenth year of refractive data collection allowing analysis and comparison of trends amongst ASCRS U.S. surgeons. Alphabet soup of refractive surgery. Alphabet soup of refractive surgery. Added questions in recent years as the field has incorporated new laser and refractive technologies including premium IOL’s, astigmatism correction, new antibiotics, steroids, NSAIA, etc. Added questions in recent years as the field has incorporated new laser and refractive technologies including premium IOL’s, astigmatism correction, new antibiotics, steroids, NSAIA, etc. Duffey 2012

4. Preferred Surgery for 30 yo -10.00 Diopter Myope Duffey 2012

5. Preferred Surgery for 45 yo +3.00 D Hyperope Duffey 2012

6. Preferred Surgery for 45 yo +5.00 D Hyperope Duffey 2012

7. Microkeratome Used Most Duffey 2012 *

8. Topography Units Used Duffey 2012 *

9. Excimer Used Most Duffey 2012 *

10. Wavefront Analyzer Duffey 2012

11. Wavefront-Guided Custom Ablations in Your Practice Duffey 2012

12. Preferred Surgery for Presbyopia (Pre-cataract) Duffey 2012

13. Post-Op Antibiotic Duffey 2012

14. Post-Op Anti-inflammatory Duffey 2012 *

15. Post-Op Non-Steroidal Duffey 2012

16. Do You Perform Simultaneous Bilateral Surgery? Duffey 2012

17. Family Refractive Surgery Index Duffey 2012

18. Do You Intra-operatively Measure Flap Thickness? Duffey 2012

19. Preferred Flap Thickness (when no other constraints) Duffey 2012 *

20. Minimum Residual Stromal Bed Thickness Requirement Duffey 2012 *

21. Total Cases of Post-LASIK Ectasia as the Primary Surgeon in Career Duffey 2012 * NO CHANGE

22. Minimum Preop Corneal Pachymetry for LASIK (all other parameters normal) Duffey 2012

23. Minimum Final Corneal Thickness Allowable Following PRK (including epithelium) Duffey 2012

24. Mitomycin-C Use (MMC) Duffey 2012

25. Will Perform Refractive Surgery On One-Eyed Patients Duffey 2012

26. Comanagement

27. When Comanaged: Who Sees Postop LASIK Patient on Day 1 ? Duffey 2012

28. Minimum “OR” Location for Phakic-IOL Surgery Duffey 2012

29. Refractive Surgery Volumes (extrapolated data in thousands) Duffey 2012 Overall 7% decrease in LVC from ‘09 to ’11 PRK represents 26% of LVC (12% in 2005)

30. Duffey 2012 2011 ASCRS SUMMARY U.S. membership volume of LVC in 2011 decreased to 697,000 eyes. Total of 12-13 million since 1996 within ASCRS. U.S. membership volume of LVC in 2011 decreased to 697,000 eyes. Total of 12-13 million since 1996 within ASCRS. LVC volume down 35% over past seven years. LVC volume down 35% over past seven years. PRK increased to 26% of LVC (12% in 2005) PRK increased to 26% of LVC (12% in 2005) VisX at > 2:1 (65%) over all other lasers combined. Wavelight increased to 27% since purchased by Alcon. VisX at > 2:1 (65%) over all other lasers combined. Wavelight increased to 27% since purchased by Alcon. Femtosecond laser market share flat at 53% over past two years. Femtosecond laser market share flat at 53% over past two years.

31. Duffey 2012 2011 ASCRS SUMMARY P-IOL (46%) preferred to LVC (36%) in high myopes. RLE (57%) for high hyperopes. P-IOL (46%) preferred to LVC (36%) in high myopes. RLE (57%) for high hyperopes. 100 micron flap thickness is favored by 45% of surgeons (up from 11% seven years ago). 100 micron flap thickness is favored by 45% of surgeons (up from 11% seven years ago). 40% (stable) think 250 microns is adequate for RST. 55% say 275-300 microns is better (21% in ’04). 40% (stable) think 250 microns is adequate for RST. 55% say 275-300 microns is better (21% in ’04). 26% of respondents are OK with bilateral P-IOL (11% seven years ago) and 7% with RLE (stable) at the same surgical setting. 26% of respondents are OK with bilateral P-IOL (11% seven years ago) and 7% with RLE (stable) at the same surgical setting.

32. 2011 ASCRS SUMMARY 52% of surgeons are OK with LASIK in corneas <500 um. 52% of surgeons are OK with LASIK in corneas <500 um. Still only 42% of refractive surgeons have had one or more documented cases of post-LASIK ectasia in his/her surgical patients over a career (overall incidence stable over past three years). Still only 42% of refractive surgeons have had one or more documented cases of post-LASIK ectasia in his/her surgical patients over a career (overall incidence stable over past three years). High penetration of modern refractive surgery (LVC) amongst refractive surgeons (25%), their spouses (28%), siblings (54%), and children (23%). High penetration of modern refractive surgery (LVC) amongst refractive surgeons (25%), their spouses (28%), siblings (54%), and children (23%). Duffey 2012

33. Thanks to ASCRS leadership for their support and for your participation in the 2011 Survey We look forward to your responses in the 2012 ONLINE survey this autumn. Complete results since 1997 now available at www.duffeylaser.com